BACKGROUND: Diet has been shown to be associated with rheumatoid arthritis (RA), of which osteoporosis is the most common and important complication, and zinc has been shown to inhibit the inflammatory response, but studies on the relationship between dietary zinc and osteoporosis in patients with RA are limited and inconclusive. In this study, we aimed to explore the relationship between dietary zinc intake and osteoporosis or osteopenia in patients with RA.
METHODS: Data on RA patients were derived from the National Health and Nutrition Examination Survey (NHANES) 2007 to 2010, 2013 to 2014, and 2017 to 2020. Weighted univariate and multivariate logistic regression models were performed to explore the association between dietary zinc intake and osteoporosis or osteopenia in RA patients. The relationship was further investigated in different age, body mass index (BMI), nonsteroidal use, dyslipidemia, diabetes, and hypertension population. All results were presented as odds ratios (ORs) and confidence intervals (CIs).
RESULTS: In total, 905 RA patients aged ≥ 40 years were included. After adjusting all covariates, higher dietary zinc intake was associated with lower odds of osteopenia or osteoporosis (OR = 0.39, 95%CI: 0.18-0.86) in RA patients. The relationship between dietary zinc intake ≥ 19.52 mg and lower odds of osteopenia or osteoporosis were also found in those aged ≥ 60 years (OR = 0.38, 95%CI: 0.16-0.91), BMI normal or underweight (OR = 0.16, 95%CI: 0.03-0.84), nonsteroidal use (OR = 0.14, 95%CI: 0.02-0.82), dyslipidemia (OR = 0.40, 95%CI: 0.17-0.92), diabetes (OR = 0.37, 95%CI: 0.14-0.95), and hypertension (OR = 0.37, 95%CI: 0.16-0.86).
CONCLUSIONS: Higher dietary zinc intake was associated with reduced incidence of osteopenia or osteoporosis in patients with RA. Further longitudinal and randomized trials are necessary to validate our findings and explore the underling mechanisms. Adequate dietary zinc intake may beneficial to the bone health in RA patients.

OBJECTIVE: We developed a few-shot learning (FSL) framework for the diagnosis of osteopenia and osteoporosis in knee X-ray images.
METHODS: Computer vision models containing deep convolutional neural networks were fine-tuned to enable generalization from natural images (ImageNet) to chest X-ray images (normal vs. pneumonia, base images). Then, a series of automated machine learning classifiers based on the Euclidean distances of base images were developed to make predictions for novel images (normal vs. osteopenia vs. osteoporosis). The performance of the FSL framework was compared with that of junior and senior radiologists. In addition, the gradient-weighted class activation mapping algorithm was used for visual interpretation.
RESULTS: In Cohort #1, the mean accuracy (0.728) and sensitivity (0.774) of the FSL models were higher than those of the radiologists (0.512 and 0.448). A diagnostic pipeline of FSL model (first)-radiologists (second) achieved better performance (0.653 accuracy, 0.582 sensitivity, and 0.816 specificity) than radiologists alone. In Cohort #2, the diagnostic pipeline also showed improved performance.
CONCLUSIONS: The FSL framework yielded practical performance with respect to the diagnosis of osteopenia and osteoporosis in comparison with radiologists. This retrospective study supports the use of promising FSL methods in computer-aided diagnosis tasks involving limited samples.

The objectives of this study were to investigate the composition of gut microbiota and its relationship with bone loss in the Uyghur osteopenia population, identify potential disease-related taxa and collect information for the prevention and treatment of osteopenia in different people by regulating gut microbiota. We selected Uyghur residents, measured their heel BMD, collected faeces and general information, grouped them by BMD level, obtained faecal 16S rRNA sequences, and compared and analysed the differences between the groups. This study showed that the numbers of OTUs and species in the gut microbiota in the osteopenia group were higher than those in the control. At the phylum level, Erysipelotrichia was more abundant in the osteopenia group. At the genus level, Phascolarctobacterium was less abundant, and Ruminiclostridium_5 was more abundant in the osteopenia group compared to the control. Phascolarctobacterium and Z-score were positively correlated, and Ruminiclostridium_5 was negatively correlated with T and Z score. The different composition of the gut microbiota in Uyghur osteopenia patients and controls found in this study fills a knowledge gap in this ethnic group. The relationship between Uyghur osteopenia and BMD-associated bacterial genera deserves further exploration.

A 65-year-old woman presented with right elbow pain after a fall. Imaging showed an avulsion fracture of the olecranon. The patient subsequently underwent surgery using the suture bridge technique with anchors. However, loosening was observed intraoperatively. Therefore, a McLaughlin cerclage with an artificial ligament was added, resulting in a rigid fixation. Bone union was achieved at 4 months postoperatively. At 18 months postoperatively, no limitation was observed in the range of motion of the elbow joint; the disabilities of the arm, shoulder and hand score was 0. McLaughlin cerclage with an artificial ligament provided additional fixation, demonstrating greater strength compared with suture anchors and minimizing the risk of cut-through in the osteoporotic bone. This approach offers a promising alternative for such cases by combining firm fixation with a reduced risk of complications, particularly in older patients with osteoporosis.

Osteosarcopenic adiposity (OSA) syndrome, the coexistence of osteoporosis, sarcopenia, and adiposity (either excess or redistributed/infiltrated), has been studied globally in different populations and regions (mostly in East Asia, less in Europe and North America), resulting in varied prevalence. We aimed to determine the prevalence of OSA in a large population of apparently healthy Caucasian adults (18-90 years) and to compare it with the prevalence reported in other studies and other ethnicities. This study included 9719 participants (6412 women and 3307 men), stratified into four age-group categories, and recruited from the general medical practices in Italy. OSA was defined based on body composition measurements using bioelectrical impedance BIA-ACC®, which enables assessment of total bone mass, muscle/lean, and adipose tissues. The overall prevalence of OSA was 21.9% in women and 14.0% in men, and it significantly increased in every subsequent age group for both women and men (p < 0.001). The OSA prevalence was not significantly different between men and women below 40 years; however, it was considerably higher in women over 40 years. Participants with OSA had a significantly lower BMI compared to those without OSA, indicating OSA is a separate disorder not necessarily related to physiological fluctuations of BMI. The prevalence in Asian populations was lower than in our sample, indicating ethnic specificity. The relatively high prevalence of OSA detected in this study\'s population across the age groups suggests the necessity for its appropriate and timely identification to prevent possible clinical outcomes, including fracture, dismobility, frailty, or chronic diseases.

Breast cancer (BCa) is related to chronic stress and can reduce the bone mineral density (BMD) through neurochemicals related to beta-adrenergic receptor (ADRB) 1 and 2. Selective beta blockers (sBBs) and nonselective beta blockers (nsBBs) are used to treat systemic arterial hypertension (SAH) and may have osteoprotective effects, as they inhibit ADRBs. To evaluate the effects of sBBs and nsBBs on the BMD of Mexican patients with BCa. A retrospective study was conducted. We included 191 Mexican women with BCa without SAH and with SAH treated with nsBBs, sBBs, and diuretics. BMD was evaluated using a bone density scan (DEX scan). A greater average BMD (p < 0.05) was observed in patients with prior treatment with both nsBBs and sBBs (0.54 ± 0.94 and -0.44 ± 1.22, respectively) compared to patients treated with diuretics or without SAH (-1.73 ± 0.83 and -1.22 ± 0.98, respectively). Regarding the diagnosis of osteoporosis/osteopenia, no cases were observed in patients treated with nsBBs, whereas 5.6% of the patients treated with sBBs presented osteopenia. A total of 23.1% and 10.6% patients managed with diuretics or without treatment presented with osteoporosis and 61.5% and 48% patients managed with loop diuretics and without treatment presented with osteopenia, respectively (p < 0.05). Treatment with nsBBs is a promising option for the prevention and management of osteoporosis/osteopenia in Mexican patients with BCa; however, further prospective studies are needed.

UNASSIGNED: Osteoporosis is an inflammatory disease that causes a large disease burden worldwide. Dietary inflammation index (DII), a comprehensive assessment index that reflects the pro-inflammatory/anti-inflammatory level of diet was related to multiple inflammatory diseases. This study aimed to explore the association between DII and all-cause mortality in patients with osteoporosis or osteopenia.
UNASSIGNED: In this retrospective cohort study, data of patients aged ≥ 45 years diagnosed as osteopenia or osteoporosis and had complete dietary intake information were extracted from the National Health and Nutrition Examination Survey (NHANES 2007-2010, 2013-2014, 2017-2018). Dietary intake information was obtained from 24-h dietary recall interviews and was used to calculate the DII score. Weighted univariate and multivariate Cox proportional hazard models were utilized to explore the association between DII and all-cause mortality in patients with osteoporosis or osteopenia, with hazard ratios (HRs) and 95 % confidence intervals (CIs). Subgroup analyses based on different age, gender and complications were further assessed this association.
UNASSIGNED: A total of 5,381 patients were included. Until December 31, 2019, 1,286 all-cause deaths occurred. After adjusting all covariates, high DII was associated with the high odds of all-cause mortality among patients with osteoporosis or osteopenia (HR=1.28, 95 %CI: 1.10-1.48), especially in the male (HR=1.38, 95 %CI: 1.06-1.78), aged < 65 years (HR=1.49, 95 %CI: 1.09-2.02), and without the history the cardiovascular disease (HR=1.30, 95 %CI: 1.03-1.65), diabetes mellitus (HR=1.27, 95 %CI: 1.06-1.52) and chronic kidney disease (HR=1.28, 95 %CI: 1.03-1.58).
UNASSIGNED: A pro-inflammatory diet may have an adverse effect on the prognosis of osteoporosis patients.

OBJECTIVE: The aim of this study is to evaluate the findings of existing systematic reviews (SRs) and provide scientific evidence on the efficacy and safety of whole-body vibration (WBV) in improving bone mineral density (BMD) in postmenopausal women, to provide recommendations and guidance for future high-quality clinical research and SRs.
METHODS: We conducted searches in six databases (SinoMed, CNKI, Cochrane Library, Embase, PubMed, Web of Science) from the inception of the databases until July 31, 2023. The language was limited to Chinese or English. The methodological quality, risk of bias, and evidence grade of outcomes were evaluated using AMSTAR-2, ROBIS, and GRADE, respectively. Additionally, the degree of overlap in randomized controlled trials (RCTs) among the SRs was calculated using corrected covered area (CCA). Furthermore, we performed quantitative synthesis or descriptive analysis of the relevant data. All relevant operations were independently conducted by two individuals.
RESULTS: A total of 15 SRs were included in the analysis, out of which three were qualitative descriptions and 12 were meta-analyses. According to AMSTAR-2, only two SRs were rated as low or moderate, while the remaining 13 SRs were rated as critically low quality. The ROBIS assessment indicated that seven SRs had a low risk of bias, while 8 SRs had a high risk of bias. The overall findings suggest that WBV does not have a significant advantage in improving BMD in postmenopausal women. Furthermore, the CCA results revealed a high overlap in RCTs across five outcomes among the 15 SRs. Only five SRs reported specific adverse reactions/events experienced by participants after WBV interventions, and none of the SRs reported any severe adverse events.
CONCLUSIONS: The existing evidence cannot establish definitive advantages of WBV in improving BMD in postmenopausal women. Therefore, we do not recommend the use of WBV for improving BMD in postmenopausal women. However, WBV may have potential value in maintaining BMD in postmenopausal women, further research is needed to confirm these findings.

UNASSIGNED: The purpose of this study is to investigate potential associations between osteopenia, osteosarcopenia, and postoperative outcomes in patients with hepatobiliary-pancreatic cancer (HBPC).
UNASSIGNED: Three online databases, including Embase, PubMed, and the Cochrane Library, were thoroughly searched for literature describing the relationship between osteopenia, osteosarcopenia, and outcomes of surgical treatment of HBPC patients from the start of each database to September 29, 2023. The Newcastle-Ottawa Scale was used to rate the quality of the studies.
UNASSIGNED: This analysis included a total of 16 articles with a combined patient cohort of 2,599 individuals. The results demonstrated that HBPC patients with osteopenia had significantly inferior OS (HR: 2.27, 95% CI: 1.70-3.03, p < 0.001) and RFS (HR: 1.96, 95% CI: 1.42-2.71, p < 0.001) compared to those without osteopenia. Subgroup analysis demonstrated that these findings were consistent across univariate and multivariate analyses, as well as hepatocellular carcinoma, biliary tract cancer, and pancreatic cancer. The risk of postoperative major complications was significantly higher in patients with osteopenia compared to those without osteopenia (OR: 1.66, 95% CI: 1.19-2.33, p < 0.001). Besides, we also found that the presence of osteosarcopenia in HBPC patients was significantly related to poorer OS (HR: 3.31, 95% CI: 2.00-5.48, p < 0.001) and PFS (HR: 2.50, 95% CI: 1.62-3.84, p < 0.001) in comparison to those without osteosarcopenia.
UNASSIGNED: Preoperative osteopenia and osteosarcopenia can predict poorer OS and RFS with HBPC after surgery.

Alcohol\'s detrimental effects on bone health are well established, yet some literature suggests moderate consumption may offer benefits. With alcohol use on the rise, we investigate the impact of acute and chronic alcohol administration, along with withdrawal, on male Wistar rat femurs. We observed a transient cortical thickness increase with acute alcohol (AA) compared to chronic exposure (CA) but no significant changes in trabecular parameters or mechanical properties. High osteocalcin and osteopontin expression levels were noted in AA, alongside elevated RANKL expression. Conversely, CA showed low TRAP levels. FGF23 expression significantly increased during alcohol withdrawal (AW), while GPX decreased after chronic exposure but rose during withdrawal. Although mechanical strength changes were insignificant, biochemical shifts suggest alcohol exposure promotes bone resorption, reduces antioxidant protection, and potentially hampers active vitamin D and phosphate reabsorption via FGF23 upregulation.